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        	<h1>E Gas Sewa</h1>          
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            	<li class="menuitem"><a href="index.html">Home</a></li>
                <li class="menuitem"><a href="#">About</a></li>
                <li class="menuitem"><a href="#">Products</a></li>
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	 <form name="Password" action="" >

     <table>

	 <tr><td>Firstname:</td><td><input type="text" name="text" value=""/></td>

    <td>Laststname:</td><td><input type="text" name="text" value=""></td></tr>

	 <tr><td>UserId:</td><td><input type="text" name="username" /></td></tr> <br />

	 <tr><td>Password:</td><td><input type="password" name="password" value="" /></td>

	 <td>ConfirmPassword:</td><td><input type="password" name="password" value="" /></td></tr>

	 <tr><td>Father's name:</td><td><input type="text" name="text" value=""></input></td></tr>

	 <tr><td>HintQuestion:</td><td><input type="text" name="HQ" /></td></tr> <br />

	 <tr><td>HintAnswer:</td><td><input type="text" name="HA" /></td></tr> <br />

 	 <tr><td>Gender:</td><td><input type="RADIO" name="Male" value="">Male

      <input type="RADIO" name="Male" value="">Female</td></tr>

    <tr><td>DOB:</td><td>

    <select name="day">

    <option>day</option><option>1</option><option>2</option><option>3</option><option>4</option><option>5</option>

     <option>6 </option><option>7</option><option>8</option><option>9</option><option>10</option>

     <option>11</option><option>12</option><option>13</option><option>14</option><option>15</option>

     <option>16</option><option>17</option><option>18</option><option>19</option><option>20</option>

     <option>21</option><option>22</option><option>23</option><option>24</option><option>25</option>

     <option>26</option><option>27</option><option>28</option><option>29</option><option>30</option>

     <option>31</option></select>

    <select name="month">

    <option>month</option><option>Jan</option><option>Feb</option><option>Mar</option><option>Apr</option>

    <option>May</option><option>Jun</option><option>Jul</option><option>Aug</option><option>Sep</option>

    <option>Oct</option><option>Nov</option><option>Dec</option></select>

    <select name="YEAR">

    <option>YEAR</option><option>1989</option><option>1988</option><option>1987</option><option>1986</option><option>1985</option>

    <option>1984 </option><option>1983</option><option>1982</option><option>1981</option><option>1980</option>

    <option>1979</option><option>1978</option><option>1977</option><option>1976</option><option>1975</option>

    <option>1974</option><option>1973</option><option>1972</option><option>1971</option><option>1970</option>

    <option>1969</option><option>1968</option><option>1967</option><option>1966</option><option>1965</option>

    <option>1964</option><option>1963</option><option>1962</option><option>1961</option><option>1960</option>

    </select> </td></tr>

    <tr><td> TelephoneNumber:</td><td><input type="text" name="text" value=""></input>

    </td></tr>

    <tr><td>MobileNumber:</td><td><input type="text" name="text" value=""></input></td></tr>

    <tr><td>Email_id:</td><td><input type="text" name="text" value=""></input></td></tr>

    <tr><td>Alternate Email_id:</td><td><input type="text" name="text" value=""></input></td></tr>

    <tr><td>Address:</td><td><textarea rows="2" cols="10" name="body"></textarea></textarea></td></tr>

    <tr><td>Area:</td><td><input type="textarea" rows="3" cols="10" name="body"></td></tr>

    <tr><td>PIN:</td><td><input type="text" name="pin" value="" /></td></tr>

    <tr></tr>

	<tr></tr>

	<tr><td><td><td><input type="BUTTON" value="SUBMIT">

    <input type="reset" value="RESET" /><td></td></td></tr>  </table>

	 	 	</form>


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